PMH-C Application_English_Updated Feb 2024

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Thank you for your interest in PSI Certification in Perinatal Mental Health (PMH-C). If you meet all requirements for the certification exam, please fill out the following application. You may be asked for additional documentation to determine eligibility.

For more information about the exam and requirements, and to view the PMH-C Handbook, please visit: http://www.postpartum.net/professionals/certification/

If we approve your application, Pearson VUE will direct you to register for the exam at your nearest testing center. Testing centers are available throughout the world and can be found on the Pearson VUE/PSI webpage.

If you have not met all prerequisites, please do not apply at this time.
Email certification@postpartum.net with any questions.

Postpartum Support International
Certification in Perinatal Mental Health
Exam Application

Prefix

First Name *

Middle Name

Last Name *

Legal First Name *

Legal Last Name *

My name above matches my legal ID for the purpose of identification during testing.

Enter your full name below exactly as you would like it to appear on your certificate. (May include academic degrees if desired.)

Email *

Address 1 *

Address 2

City *

State/Province (U.S./Canada)

Region/Prefecture (outside U.S./Canada)

Postal/Zip Code *

Country *

Phone # (1) *

Education and Certifications

Candidates must meet the following minimum requirements for education:

Psychotherapy/Mental Health Track - Graduate Degree
Psychopharmacology/Psychiatry/Prescriber Track - Medical Degree or Advanced Practice Nursing Degree
Affiliated Profession Track (Nurses, Doulas, Lactation, Social Support, Occupational or Physical Therapists, Dietitians, and others) - Professional Credential

PMH-C Track *

Academic background (list up to 4):
leave blank where not applicable

University/college name (1)

Year graduated (1)

Degree received (1)

University/college name (2)

Year graduated (2)

Degree received (2)

University/college name (3)

Year graduated (3)

Degree received (3)

University/college name (4)

Year graduated (4)

Degree received (4)

If checked "Other" or "Professional Credential", please provide details:

Are you able to provide transcripts from relevant educational institutions if necessary? *

Yes

Maybe

What major or concentration is associated with your highest level of education? Example: BA in Counseling/Human Development *

Professional Licenses (list up to 2):
leave blank where not applicable

License # (1)

Locality/state (1)

License # (2)

Locailty/state (2)

Other Certifications (list up to 4):
leave blank where not applicable

Certifying agency (1)

Credential awarded, if any (1)

Date of initial certification (1)

Certification expiration date (1)

Certifying agency (2)

Credential awarded, if any (2)

Date of initial certification (2)

Certification expiration date (2)

Certifying agency (3)

Credential awarded, if any (3)

Date of initial certification (3)

Certification expiration date (3)

Certifying agency (4)

Credential awarded, if any (4)

Date of initial certification (4)

Certification expiration date (4)

Professional Experience

Candidates are required to have at least 2 years of post-graduate/post-certificate experience in your professional field, including work with the perinatal population. Share your relevant work experience below.

Provider Occupation

If checked "Other", please list details:

How many years (in total) have you worked in your professional field? *

0-1 year (new to the field, recently graduated, etc.)

2-4 years

5-9 years

10-14 years

15-19 years

20-24 years

25 or more years

How much of your experience has been spent working with the perinatal population? *

What is your current title as it relates to your professional field of expertise (ie, Director of Nursing, Pediatric Nurse, etc.)? *

Name of the organization or company you work with (or your private practice), and a link to the website if possible. *

Please provide any additional information about relevant work experience (prior positions, etc.) *

Can we contact a reference or employer to verify hours? Please include name and email. *

Prior Training Experience

Candidate requirements include training from accredited organizations. List below any trainings you have attended and would like considered as part of your requirement to sit for this certification exam. There is no guarantee of approval for prior trainings; PSI will determine this on a case-by-case basis. You will need to provide certificates of completion for each training. Be sure each certificate includes your name, the course title, the hours/CEs given for the training, and the date(s) of the training.

Current requirements:
A) Completion of evidence-based perinatal mental health certificate training (14 hours in-person or remote training) and
B) Advanced training (6 hours, which must be delivered as a live/interactive training either virtual or in-person).

Step 1: 14-hour PMHD Training Requirement

PLEASE NOTE:
If you did not take one of the above trainings, you cannot complete an application at this time. Email certification@postpartum.net with questions.

Step 2: 6-hour Advanced Training Requirement

Choose from the following the training you have completed (if you completed more than one, please select the one specific to the Track you are applying for.) *

PSI - Advanced Psychotherapy

PSI - Advanced Psychopharmacology

Other

If you selected "Other", please list: 1) training name 2) completion date (month/year) 3) training location.

PLEASE NOTE:
If you have not taken an approved advanced training, you cannot complete an application at this time. Email certification@postpartum.net with questions.

Non-disclosure Agreement

Submission of the PMH-C application indicates that you agree to the following non-disclosure agreement. This agreement will also be presented at the start of the exam at your test appointment.

The PMH-C exam is confidential and is protected by trade secret law. It is made available to you, the examinee, solely for the purpose of becoming certified in the technical area referenced in the title of the exam. You are expressly prohibited from disclosing, publishing, reproducing, or transmitting this exam, in whole or in part, in any form or by any means, verbal or written, electronic or mechanical, for any purpose, without the prior express written persmission of Postpartum Support International (PSI).

Non-disclosure Agreement *

By checking this non-disclosure agreement, I agree not to disclose the content of the PMH-C exam.

Documentation and Next Steps

If you have not already done so, submit your documentation here: https://form.jotform.com/231154477872058. Applications cannot be approved without documentation.

Applications with complete training records will be reviewed and approved first. If you have not met/completed all of the above requirements, please do not apply at this time.

I have reviewed the Next Steps above and am prepared to submit required documentation. Please type "yes" in the box below.

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Accessibility

PMH-C Exam Language *

Will accommodations be necessary? *

Accommodations are to be reserved now, not after you have submitted this application. This is necessary in securing the correct reservation for you with the testing center.

Once your application is reviewed, you will receive an email from certification@postpartum.net requesting additional documentation to support the accommodation request.

Accommodation: Extra Time

Accommodation: Separate Room

Accommodation: Nursing Space

Accommodation: Other

Demographics (optional)

Demographics details help us know our progress in reaching out to providers and others to reflect the broad array of people/communities impacted, and will help our programs.

Which describe your race or origin? (You can make multiple selections.)

Asian [Asiático/a/e] [Asiatique]

Black/African [Negro/a/e o Africano/a/e] [Noir/Africain]

Latinx/Hispanic [Latinx o Hispane] [Latino/Hispanique]

Middle Eastern or North African [Del Oriente Medio o África del Norte] [Moyen-Orient ou Afrique du Nord]

Native American/First Nations [Nativo/a/e americano/a/e o Primeras naciones] [Amérindien/Premières Nations]

Pacific Islander (incl. Native Hawaiian) [Isleño/a/e del Pacífico (incluido nativo/a/e de Hawái)] [Insulaire du Pacifique (y compris Hawaïen d'origine)]

White/European [Descendencia blanca/europea] [Blanc/Européen]

Other race or Origin [Otra raza y/u origen] [Autre origine ethnique ou raciale]

Other race or origin

Gender

Birth year (yyyy)

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